Bone metastases
Bone metastases
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DOI：
10.1038/s41572-020-00216-3
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发表时间：
2020-10-15
影响因子：
81.5
通讯作者：
Costa, Luis
中科院分区：
文献类型：
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作者：
Coleman, Robert E.;Croucher, Peter I.;Costa, Luis
骨是许多癌症最常见的转移部位，特别是乳腺癌和前列腺癌。肿瘤细胞可以从原发肿瘤部位逃逸并在骨微环境中定植。在骨内，这些播散的肿瘤细胞以及在多发性骨髓瘤的背景下产生的那些肿瘤细胞可以呈现休眠状态，在恢复增殖并引起明显转移之前保持静止数年，这通过激活破骨细胞介导的骨质溶解引起骨破坏。这种结构性损伤可导致相当大的发病率，包括疼痛、骨折和生活质量受损。虽然骨转移瘤和骨髓瘤骨病的治疗很少是治愈性的，但在多学科支持性治疗的背景下，通过使用全身性抗癌治疗，疾病控制通常可以持续多年。这种护理应包括骨靶向药物，以抑制肿瘤相关的骨质溶解和预防骨骼发病，以及使用适当的局部治疗，如放射治疗、骨科手术和专科姑息治疗，以尽量减少转移性骨病对身体功能的影响。在这篇文章中，我们概述了实体瘤和骨髓瘤骨转移的临床特征、病理生理学和具体的治疗方法。大多数癌症患者，特别是乳腺癌或前列腺癌患者，都会发生骨转移。在这篇文章中，科尔曼和他的同事们讨论了转移性骨疾病的流行病学、病理生理学和诊断，并强调了预防疾病进展和管理骨骼疾病的具体治疗策略。
Bone is the most frequent site for metastasis for many cancers, notably for tumours originating in the breast and the prostate. Tumour cells can escape from the primary tumour site and colonize the bone microenvironment. Within the bone, these disseminated tumour cells, as well as those arising in the context of multiple myeloma, may assume a state of dormancy, remaining quiescent for years before resuming proliferation and causing overt metastasis, which causes bone destruction via activation of osteoclast-mediated osteolysis. This structural damage can lead to considerable morbidity, including pain, fractures and impaired quality of life. Although treatment of bone metastases and myeloma bone disease is rarely curative, disease control is often possible for many years through the use of systemic anticancer treatments on a background of multidisciplinary supportive care. This care should include bone-targeted agents to inhibit tumour-associated osteolysis and prevent skeletal morbidity as well as use of appropriate local treatments such as radiation therapy, orthopaedic surgery and specialist palliative care to minimize the impact of metastatic bone disease on physical functioning. In this Primer, we provide an overview of the clinical features, the pathophysiology and the specific treatment approaches to prevent and treat bone metastases from solid tumours as well as myeloma bone disease.The majority of individuals with cancer, notably those with breast or prostate cancer, will develop bone metastases. In this Primer, Coleman and colleagues discuss the epidemiology, pathophysiology and diagnosis of metastatic bone disease and highlight the specific treatment strategies to prevent disease progression and to manage skeletal morbidities.